gms | German Medical Science

Objective: Indication and treatment of intracerebral arterio-venous malformations (AVMs) are complex and referring to the current literature in some aspects controversial. Besides conservative observation, widely-accepted treatment options encompass microsurgical resection, embolization, a combination of both, or radiotherapy.

Methods: In order to address this issue, we implemented an interdisciplinary AVM conference in our University hospital in 2012, where Neurosurgeons, Neurologists, interventional Neuroradiologists, and Radiotherapists discuss each patient. On a monthly basis, clinical data, MRI images and angiographies (DSA) are evaluated and a common treatment recommendation is assigned.

Results: The number of yearly evaluated patients has continuously increased from 38 (2012) to 75 (2019). In addition, the indication for surgery has also significantly increased in this time period. During an overall observation time from 2004 until 2019, 122 patients were surgically treated or in combination (embolization + surgery). 31% of all cases showed an intracerebral hemorrhage, whereas 69% were elective cases. In accordance with the Spetzler-Martin score, we considered 22% as grade I, 35% as grade II, 37% as grade III, 6% as grade IV, and 0% as grade V. In 96% of patients, the AVM was totally resected without any hints of remaining pathological vessels on the postoperative angiography. Overall, we achieved a favorable outcome (mRS 0-1) in 72% of all cases, however, considering the elective cases without a hemorrhage only, 94% of all patients had a favorable outcome.

Conclusion: Due to the implementation of an interdisciplinary AVM conference, decision making for treatment indication was pulled-up, the number of surgical interventions increased and the overall treatment quality for AVM patients could be improved.